How to fill out the R20 form — Complete guide

A common misconception : there is no single "R20 form" that you fill out yourself. The Assurance Dépendance application is made up of two separate documents that must arrive together at the Caisse Nationale de Santé :

1. The benefits application form — which you fill in (or a family member, or your legal representative).
2. The R20 medical report — which your treating doctor fills in. This report is free for you : the CNS pays your doctor directly.

Your file is only considered complete once both documents have reached the CNS. Neither one alone decides your eligibility — the Administration d'Évaluation et de Contrôle (AEC) then assesses your situation independently.

Anyone affiliated with Luxembourg's social security system who experiences difficulties with essential daily activities (moving around, climbing stairs, getting up, using the toilet) can submit an application. There is no minimum age requirement.

The application can be submitted by the person themselves, a family member, their GP, or a social worker. The process is free and non-binding — even if you're unsure about eligibility, the AEC assessment costs nothing.

This is the form where you describe your own situation and specify the technical aid you are requesting. The official PDF is available on Guichet.lu :

Download the benefits application (PDF, Guichet.lu)

Section A — Applicant identification

Enter your full personal details : surname, first name, date of birth, matricule number (13 digits), address, phone number. If the application is made by a third party, include their contact details as well.

Section B — Description of your situation

The most important part. Describe concretely the difficulties you face in daily life. Be precise and honest — the AEC will base its assessment on this description.

Examples of helpful descriptions :

• "I can no longer climb the stairs without risk of falling"
• "I have to hold on to the railing and stop at every step"
• "I need help getting up from the toilet"
• "Since my hip operation, I can no longer reach the upper floor"

Section C — Technical aids requested

Specify exactly what you are requesting. For example : "Installation of a stairlift to access the first floor" or "Aerolet toilet seat lift". The more precise your description, the faster the evaluation.

Section D — Signature and submission

Sign the form. Don't send it yet — wait for the R20 medical report so your file is complete.

The R20 is the medical report : your treating doctor details your health status, your conditions, your functional limitations, and the likely course of your situation. The R20 cannot be downloaded — your doctor writes it themselves on a CNS form and sends it either to you (to attach to your application) or directly to the CNS.

Practical points :

• Book an appointment with your treating doctor and explain that you are applying for Assurance Dépendance for a specific technical aid (e.g. a stairlift).
• The R20 is free for you — the CNS pays your doctor directly for writing the report.
• It is not your doctor who decides whether you are dependent. Their role is to document your medical condition. The decision is then made by the AEC assessor at a home visit.
• Allow 1 to 3 weeks between your medical appointment and receiving the R20.

For a complete file, attach to the benefits application and R20 :

1. A detailed quote from the supplier — MPG provides an AEC-compliant quote. The essential document that prices the requested technical solution.
2. A copy of your CNS card
3. Any additional useful documentation (hospital reports, specialist letters, fall incident records)

Send your complete file to :

Caisse Nationale de Santé
Administration d'Évaluation et de Contrôle de l'Assurance Dépendance
L-2979 Luxembourg

You can also submit in person or electronically via MyGuichet.lu.

After receiving your file, the AEC sends an assessor to your home to evaluate your situation. This visit is free. The assessor writes a report determining the benefits granted.

The average processing time is 2 to 4 months. In cases of medical urgency, an expedited procedure is available.

At MPG, we don't fill out the R20 form for you — that's a personal matter between you and the CNS. But we support you with everything else :

Before your application :

• Free technical home visit to assess the best solution
• Advice on how to describe your situation and what technical aid to request
• Detailed quote that meets AEC requirements — the essential document to attach to your R20

During processing :

• We remain available if the AEC has technical questions about the quote
• If the assessor needs clarification on the proposed solution, we respond directly

After approval :

• Planning and installation of your equipment within 2 to 3 weeks
• Invoicing in accordance with the AEC decision
• Ongoing maintenance and support

75 % of our installations receive Assurance Dépendance coverage. Some of our clients receive 100 % coverage.